中华内科杂志
中華內科雜誌
중화내과잡지
CHINESE JOURNAL OF INTERNAL MEDICINE
2010年
6期
508-511
,共4页
薛丽凤%杨博%周决%王小钦%林果为
薛麗鳳%楊博%週決%王小欽%林果為
설려봉%양박%주결%왕소흠%림과위
骨髓增生异常综合征%贫血%再生障碍性%流式细胞术%诊断,鉴别%难治性血细胞减少伴多系发育异常
骨髓增生異常綜閤徵%貧血%再生障礙性%流式細胞術%診斷,鑒彆%難治性血細胞減少伴多繫髮育異常
골수증생이상종합정%빈혈%재생장애성%류식세포술%진단,감별%난치성혈세포감소반다계발육이상
Myelodysplasia%Anemia,aplastic%Flow cytometry%Diagnosis,differential%Refractory cytopenia with multiple dysplasia
目的 评价流式细胞术(FCM)在骨髓增生异常综合征(MDS)亚型难治性血细胞减少伴多系发育异常(RCMD)和再生障碍性贫血(AA)的鉴别诊断中的价值.方法 回顾性盲法分析168例RCMD和77例AA患者的骨髓流式数据,比较流式分析结果与诊断金标准进行诊断试验评价.结果 单个免疫表型的异常用于鉴别诊断RCMD和AA,特异度较高(75.3%～100.0%),但灵敏度较低(5.4%～50.0%).用提高灵敏度的平行试验重新进行评价,CD+34细胞≥1%、髓系原幼细胞≥3%、粒细胞CD117异常表达这3项指标联合髓系原幼细胞CD13表达缺失或粒细胞CD33表达增强,诊断的灵敏度有了较大提高(>62%),而特异度没有明显降低(>92%).根据上述评价得出的不同诊断价值,对8个原幼细胞和髓系异常抗原表达指标给以不同评分,以积分值≥1.5分判断为RCMD,<1.5分判断为AA,灵敏度和特异度均较高,在RCMD与AA组,分别为64.9%和93.5%.结论 单个免疫表型指标鉴别诊断RCMD和AA,特异度高,但灵敏度较低.CD+34细胞≥1%、髓系原幼细胞≥3%和粒细胞CD117异常表达这3项指标与其他几项组合可获得较好的灵敏度和特异度.积分法可以更精确地鉴别RCMD和AA.
目的 評價流式細胞術(FCM)在骨髓增生異常綜閤徵(MDS)亞型難治性血細胞減少伴多繫髮育異常(RCMD)和再生障礙性貧血(AA)的鑒彆診斷中的價值.方法 迴顧性盲法分析168例RCMD和77例AA患者的骨髓流式數據,比較流式分析結果與診斷金標準進行診斷試驗評價.結果 單箇免疫錶型的異常用于鑒彆診斷RCMD和AA,特異度較高(75.3%～100.0%),但靈敏度較低(5.4%～50.0%).用提高靈敏度的平行試驗重新進行評價,CD+34細胞≥1%、髓繫原幼細胞≥3%、粒細胞CD117異常錶達這3項指標聯閤髓繫原幼細胞CD13錶達缺失或粒細胞CD33錶達增彊,診斷的靈敏度有瞭較大提高(>62%),而特異度沒有明顯降低(>92%).根據上述評價得齣的不同診斷價值,對8箇原幼細胞和髓繫異常抗原錶達指標給以不同評分,以積分值≥1.5分判斷為RCMD,<1.5分判斷為AA,靈敏度和特異度均較高,在RCMD與AA組,分彆為64.9%和93.5%.結論 單箇免疫錶型指標鑒彆診斷RCMD和AA,特異度高,但靈敏度較低.CD+34細胞≥1%、髓繫原幼細胞≥3%和粒細胞CD117異常錶達這3項指標與其他幾項組閤可穫得較好的靈敏度和特異度.積分法可以更精確地鑒彆RCMD和AA.
목적 평개류식세포술(FCM)재골수증생이상종합정(MDS)아형난치성혈세포감소반다계발육이상(RCMD)화재생장애성빈혈(AA)적감별진단중적개치.방법 회고성맹법분석168례RCMD화77례AA환자적골수류식수거,비교류식분석결과여진단금표준진행진단시험평개.결과 단개면역표형적이상용우감별진단RCMD화AA,특이도교고(75.3%～100.0%),단령민도교저(5.4%～50.0%).용제고령민도적평행시험중신진행평개,CD+34세포≥1%、수계원유세포≥3%、립세포CD117이상표체저3항지표연합수계원유세포CD13표체결실혹립세포CD33표체증강,진단적령민도유료교대제고(>62%),이특이도몰유명현강저(>92%).근거상술평개득출적불동진단개치,대8개원유세포화수계이상항원표체지표급이불동평분,이적분치≥1.5분판단위RCMD,<1.5분판단위AA,령민도화특이도균교고,재RCMD여AA조,분별위64.9%화93.5%.결론 단개면역표형지표감별진단RCMD화AA,특이도고,단령민도교저.CD+34세포≥1%、수계원유세포≥3%화립세포CD117이상표체저3항지표여기타궤항조합가획득교호적령민도화특이도.적분법가이경정학지감별RCMD화AA.
Objective To evaluate the value of flow cytometry ( FCM) for the differential diagnosis between myelodysplasia (MDS) subtype refractory cytopenia with multiple dysplasia (RCMD) and aplastic anemia (AA). Methods The flow cytometric data of bone marrow samples from 168 cases of RCMD and 77 cases of AA were analyzed retrospectively in blind, and its results were compared with gold standard to evaluate its diagnosis values. Results The specificity of abnormal of single immunophenotype in the surface of granulocytes and myeloblasts was high (range 75.3% -100% ) , but the sensitivity was very low (range 5.4%-50% ). In parallel tests, the sensitivity and specificity of the combination of CD+34 cells≥1% , myeloblasts ≥3% , abnormal expression of CD117 in granulocytes and loss of CD13 in myeloblasts or increased intensity of CD33 in granulocytes were higher than other combinations. The sensitivity and specificity of above combination were more than 62% and 92% , respectively. In the scoring method,different score was given to 8 markers according to different diagnostic value, which were CD+34 cells ≥1 % ,myeloblasts≥3% , abnormal expression of CD117 in granulocytes, loss of CD13 in myeloblasts, increased intensity of CD33 in granulocytes, loss of CD13 in granulocytes, loss of CD10 in granulocytes, and decreased SSC in granulocytes. The sensitivity and specificity were both high if we defined that the total score ≥1.5 was RCMD and the score < 1. 5 was AA. Conclusions The value of abnormal of single immunophenotype for differential diagnosis between RCMD and AA is low. Parallel tests can increase the diagnostic sensitivity obviously and not decrease the specificity. CD+34 cells≥1% , myeloblasts≥3% and abnormal expression of CO117 in granulocytes were the most important markers. The scoring method is precise to distinguish RCMD from AA.
